| NPI | 1831803584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11034719) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704313517) |
| Enumeration Date | 2023-01-09 |
| Last Update Date | 2024-09-12 |